Peter Koshland, Pharm.D
Peter Koshland, Pharm.D, is a graduate of the UCSF School of Pharmacy, where he is currently an Adjunct Professor of Clinical Pharmacy and a member of the Alumni Association’s Board of Directors. He is committed to the health and well-being of his patients through close collaboration with practitioners in the application of evidence-based medicine. In 2009, Peter opened Koshland Pharm: Custom Compounding Pharmacy, which became the first compounding pharmacy in San Francisco to be accredited by the Pharmacy Compounding Accreditation Board (PCAB). Koshland Pharm makes customized medications and specializes in bioidentical hormone replacement therapy, veterinary medications, and pain management.
The intention of this blog is to 1) to support discussions about holistic, integrative, evidence-based approaches to health and healing, 2) to raise awareness about compounded (or customized) medications as a treatment option when a standard treatment is not working, and 3) to provide useful, evidence-based information about bioidentical hormones from a pharmacist’s perspective.
Because each individual’s treatment plan for any condition needs to be worked out with her doctor and pharmacist, Peter cannot give specific treatment recommendations through this blog. If you are looking for a practitioner to work with in your area, you might ask a local compounding pharmacy for a referral. To find a compounding pharmacy in your area that has been accredited by the the Pharmacy Compounding Accreditation Board (PCAB), go to PCAB’s website. If you live in California, you can check out Koshland Pharm’s practitioner referral page.
Hi Peter,
Was so saddened to hear about the closing of Elepahant Pharm. I once had a conversation with you about Bioidentical Hormones for perimenopausal symptoms. I am just beginning to explore my options in dealing with this life change and I felt that I had lost a great resource when the pharmacy closed. I have seen Dr. Sondra Altman about my issues and her solution was to put me on birth control pills. I don’t feel comfortable with this at all and have decided not to go this route. So I guess I am still searching for a Doc that will help me. Have you moved on to another Pharmacy? If so, which one? I hope you are doing well and have found a place to continue your work. Thanks, Jeanne
Thanks Jeanne,
I’m hoping to provide much of the information in this blog that I do in my talks. The great thing about a blog is that it invites comments so I can hopefully address areas that may be of particular interest to a reader. Currently, I haven relocated to another pharmacy (a situation I hope to rectify soon), and I will let you know where I end up. Thanks for posting a comment and for your kind words.
Thank you so much for commenting on my blog! I am going to post about yours right now, and I will get a link to it by the end of this week (it’s on my to do list, today is crazy, we got 5 inches of snow in Charlotte!) With best wishes, Holy Hormones!
Who is that darling baby in the photograph? Such a beauty!
I am the lucky girl who got to spend her life watching The Compounder (aka Peter, my brother) tinkering with his chemistry set, erector sets and other incredibly smart toys compared to my dolls and board games. I always knew Peter would be going big places in the intelligent world! He has always taken such care and has worked so hard his whole life to get to this place now. I am incredibly proud of THE COMPOUNDER. His success is assured due to his carefulness and care. I am glad i am your sister peter. You go dude!
xoxo,
Emelie
Peter, I have a question, how will the Pfizer/Wyeth merger possibly affect BHRT? If I am not mistaken, Wyeth is the company that has absolutely gone after the compounding pharmacies for dispensing bioidentical hormones, and on the other hand, doesn’t Pfizer make one of the ingredients that is then shipped to compounding pharmacies to be made into the creams, etc. dispensed to patients? Thanks in advance for any insight you can provide, have a wonderful weekend!
It’s no secret that Wyeth (the maker of Prempro) was no friend to the compounding pharmacist. They used their financial and politicial clout to influence the FDA to go after compounding pharmacies that were dispensing bioidentical hormones. I guess they felt a little threatened by the mountain of scientific evidence supporting bioidentical hormones over their synthetic and horse derived products. Thanks to massive grass roots efforts by women across the country, who called and wrote their congresspeople, we were able to hold Wyeth at bay for the most part.
Now that Wyeth is going to be merged into Pfizer, it is difficult to say how the Pfizer/Wyeth merger will affect Wyeth’s efforts. Will Pfizer pursue the aggressive efforts that Wyeth initiated? My guess is no. Not so much because that Pfizer is such a kind hearted company, but more because of the political change in Washington. I expect to see positive shift towards patient’s needs and away from drug company’s needs with the current and upcoming appointments from the Obama administration.
With that said, I haven’t totally put my guard down. In 2001, before the results of the Women’s Health Initiative, sales of Prempro topped $2 billion, so there is still a huge financial incentive to intimidate compounding pharmacies and distort the evidence about bioidentical hormones. We still need to be ready to go back to our congresspeople if the FDA or anyone threatens to take our hormones away.
Just a quick question about the BHRT critics. You mentioned that they say there is no evidence to support BHRT. From what I’ve read, they acknowledge the benefits of mass produced prescription products, but not the compounded hormones. Does that sound like a fair representation, or are they actually nay saying the BHRT in general?
Thanks for the question, Rob.
I guess it depends on who you talk to. Some are opposed to the entire notion of bioidentical hormones and prefer the equine and synthetic hormones. Others want only the mass producted products since they are manufactured with the FDAs oversight. I just discovered another blog that wrote a lengthy post criticizing both compound pharmacies and the notion of bioidentical hormones. You can check it out at http://sciencebasedpharmacy.wordpress.com/2009/03/13/bioidentical-hormone-replacement.
In future posts, I hope to answer many of the criticisms to BHRT that this blogger and others have. It is a topic that deserves a serious, science based debate.
Hi Peter,
Love your blog. Thought you might be interested in this article I wrote in my newsletter — Letter to Oprah about Bioidentical Hormones: http://www.virginiahopkinstestkits.com/bioidenticalhormonebreastcancer.html
I also have articles about the FDA/Wyeth/Estriol/Bioidenticals battle: http://www.virginiahopkinstestkits.com/estriolcongress.html
I am new to this and blogging. Is there a specific place where I can get a specific question answered?
Thanks.
Go ahead and post your question in the comments section and I’ll do my best to answer it. Thanks.
Hi Peter,
Glad to have found your website!
I am using bioidentical harmones for last 3 years. Started mainly due to daily headaches. I started at low dose, but currently I am taking 600mg of progesterone cream and 2 mg of biest. I know it is a high dose. I divide it up during the day. I have kept a diary of my symptoms and anything less than 550mg of progesterone, I get headaches, daily headaches. I added biest recently to help balance out the high progesterone and to prevent breakthrough bleeding resulting from a high progesterone dosing. With this combination, I feel alert and can function well. Would you recommend it is safe to continue. I am 43, my mom had menopause early. I am not able to get help from my regular doctors. Appreciate your help.
Dawn.
Hi–
I tried to research the site before asking this question–because I doubt that I am the first to ask….but, I couldn’t find my answer.
I just put on 6 pounds (around my belly) from an adjustment in my bio-identical hormones. My doctor doubled my estrogen and left my progesterone as it was. She indicated that my blood values BOTH were too low for her liking….but, I am wondering what “normal” looks like in a 58 year old woman, who had a hysterectomy over 15 years ago.
I have fibromyalgia–can’t afford to have this extra weight–I’ll NEVER be able to exercise it off!!
A second question—I am using 200mg of progesterone cream. The pharmacist that I have switched to since moving–said that that is a VERY high dose and must not be getting absorbed. If I went to compounded tablets–wouldn’t the it be even MORE difficult–since it has to by-pass the liver, first? I don’t have any problems on the 200mg (unless that is causing my new belly fat)–in other words, I don’t feel sleepy nor do I feel particularly CALM!
Thanks,
Lynn
Yes, 200mg of topical progesterone is a very high dose. This is more typical of an oral dose for progesterone. The progesterone is definitely going into your body. The question is, is it reaching the target cells where it can have its effect. Progesterone (and other hormones) can get trapped in adipose (or fat) cells, so it is important to apply it to a lean part of your body. This is why the inside of the wrist is generally recommended application point. Also, I would recommend getting a saliva test if you haven’t done so already. As I mentioned in my last blog posting, blood testing does not accurately reflect hormone levels after supplementation. If your saliva levels come back high, I would recommend taking a hiatus from the progesterone cream for a short time to allow your levels to come down. I’m not sure what dose of estrogen you are on, but it would be worthwhile to look estradiol as well with the goal of finding the right dose of both estradiol and progesterone for hormonal balance.
Good luck!
Thanks. Unfortunately, the OBGYN that I see does not believe in saliva testing. I have scheduled an appt with a new doc–and hopefully, he will adjust things. I LIKE the progesterone at the dose that I have…..it is the estradiol that I’m having a problem with (I think). It is only .05 patch—but, it has added about 3 inches to my mid-section….can THAT happen? It seemed to come on very quickly when I started using it–and I also gained five pounds in a relatively short amount of time.
I think it’s funny that someone doesn’t “believe” in saliva testing. It makes it sound like Santa Claus or something. All you doctor has to do is look at the scientific literature, although many doctors simply don’t do that. I’m glad you are finding a new doctor who, hopefully, has a more open mind.
Rapid weight gain is a common symptom of peri-menopause. The estrogen may be the culprit, so may the progesterone, or it may be a combination of both. Have your doctor look at the big picture with the goal of balancing the hormones and I believe your will see the best results. Good luck!
Thanks. Problem is that I’m not IN perimenopause…I had a total/complete hysterectomy 15 years ago!
Right. I apologize for implying that you were in perimenopause. I guess what I meant to say was that when the hormone output of the ovaries is disrupted either through a hysterectomy, or through menopause, sudden weight gain is possible, and that hormone balancing can help with that.
Hi Peter!
I finally got a chance to sit down and read your blog. Very informative and cuts thru the “bull” quickly. You will soon need an ‘updated’ profile pic!
Hello,
Thank you for such a wonderful and informative blog.
Do you have any suggestions for finding a provider of BHRT? I had one, but moved 900 miles away, and it is impossible to maintain therapy. I’ve called dozens of OB/GYN’s and even a componding pharmacy, but have had no success.
Thank you!
Hi Peter!
What a great informative and truthful blog about bioidentical hormones. We are currently working on a book titled, “Stay Young & Sexy” discussing bioidentical hormones and anti-aging. Do you mind if we add your blog to our blog roll? Ours is http://stayyoungandsexy.wordpress.com. It’s very new but feel free to comment, post or add us to your blogroll. Have a great day!
-Annette
No problem. Good luck to you and thanks for helping spread the truth about bioidentical hormones.
Hello Peter,
I’m pretty sure this will sound as an odd question but I must give it a try.
Namely, since it is absolutely impossible to obtain any kind of commercial porcine desiccated thyroid here in Serbia I decided to get some fresh porcine thyroids from local slaughterhouses and prepare my homemade desiccated thyroid. May I have your assistance in doing this? Or, should I consider the recipe as a trade secret? However I’ll appreciate your comment.
All the best in your compounding business from
Ljubica
P.S. I’m a molecular biologist by background education with a considerable knowledge in medicine and biochemistry.
Hi Ljubica,
I buy all my powders USP grade. I have no idea how to purify fresh porcine thyroid glands. Good luck, though.
Peter
Dr. Koshland,
Your work is amazing. Thank you for sharing your insights and clinical experience!
(ur on my blogroll)
-Dr.BG
love this site. so much great knowledge here don’t even know how i found it. I just had my saliva test and will start my bioidentcal hormone therapy soon.
Are you related to Marian and Dan?
Distantly
Do you know how I can find a compounding pharmacist to review a recipe I have put together for a facial treatment/product? I want to make my own so as to avoid the parabens and other additives. I just want to sent the recipe and see if there is anything that will interact in a strange way, or if there is an ingredient that needs to be stabilized somehow.
You should be able to find a compounder in your area at http://www.findacompounder.com.
Great article, Peter. We are sharing it with your fellow International Academy of Compounding (IACP) Members. Thanks for helping to set the record straight on pharmacy compounding.
I have been on Tri-est for 18 months and progesterone for 24 months. I’ve had my tri-est increased 4 times in 18 months and my dr told me that I am at the maximum amount of 1.25mg cream. I should note that Im also taking
c-progesterone in a capsule (powder) at 300mg, both taken at night. My pharmacist said she can’t increase tri-est above 1.25 and I need to consider having my thyroid tested. My thyroid is within normal limits on medicine. I am on levothyroxin 50mcg. I am still having hot flashes, which occur about 4 times a night, sometimes lasting 20 minutes each time. Now I feel like my dr is going to have to put me on traditional HRT, which I do not want to do. However, I must have help with this sleep deprivation and hot flashes. I thought this more natural approach was an answer for those that don’t want traditionl HRT. WHat can I do about this? Is it really true that 1.25 is the limit for tri-est? I don’t know what to do!
I just started a petition in NC regarding BCBS no longer covering compounded medications…I thought this may be of interest to you with your work or maybe you could pass it along to others who it may affect:
http://signon.org/sign/blue-cross-blue-shield?source=c.fwd.in&r_by=6853786